Concerns Over Prostate Cancer Overtreatment
A charity has raised alarms that as many as 5,000 men each year may be subjected to unnecessary overtreatment for prostate cancer due to outdated guidelines. This issue, it seems, is prompting significant concern among health advocates.
According to Prostate Cancer UK, overtreatment often leads to serious side effects including erectile dysfunction and incontinence. Many patients, particularly those whose cancer is unlikely to progress, might only require close monitoring. However, experts point out that the aging guidelines from the National Institute for Health and Care Excellence (NICE) have led to what some are calling a “wild west” scenario in how care is administered within the NHS.
The warning is particularly timely, as the government is pending guidance on a national screening program for prostate cancer. This discussion gained momentum following Sir Chris Hoy’s disclosure in February 2024 of his stage four prostate cancer diagnosis, which has sparked calls for more men to get screened.
Statistics suggest that about one in four men diagnosed with prostate cancer are dealing with a slow-growing form of the disease that will probably not harm them. Currently, NICE only recommends active surveillance as the primary method for men with low-risk cancer, but many believe these guidelines have not evolved with advancements in testing and diagnosis since 2021.
Professor Vincent Gnanapragasam from the University of Cambridge noted, “Active surveillance is the optimal treatment for men whose cancer is unlikely to progress. Yet, the outdated NICE guidelines have created concerning discrepancies in how this surveillance is carried out by different health care teams. This inconsistency can lead to a lack of confidence among patients, who might then opt for unnecessary treatments, exposing themselves to unwanted side effects.”
The data shows overtreatment rates in England range from 2 to 24 percent, resulting in a “postcode lottery.” This means some men may receive needless treatment while others get appropriate monitoring. Alarmingly, around 35 hospitals have established their own treatment protocols.
Take Michael Lewis, a 63-year-old nurse from Dudley, who was diagnosed with prostate cancer in 2020. He shared, “My doctors indicated that my cancer was low-risk and not expected to spread quickly. I was on active surveillance until 2024 when my PSA levels started rising, prompting surgery to remove my prostate. Being under active surveillance meant I could avoid treatment until necessary, allowing me to maintain a normal life without side effects.”
Amy Rylance, assistant director of health improvement at Prostate Cancer UK, highlighted that due to advances in research, medical professionals can now better discern which prostate cancers need immediate intervention and which can be monitored, allowing some men to delay or even avoid treatment altogether. She cautioned that various treatments can carry significant side effects, influencing both mental and physical health.
Rylance emphasized, “NICE’s outdated guidance is increasing the chances of men experiencing these life-altering side effects and is resulting in confusion among hospitals regarding active surveillance, ultimately leading to that postcode lottery of overtreatment.”
The charity is reiterating its appeal for NICE to reconsider and update its active surveillance guidelines, which they believe could prevent overtreatment for thousands of men annually.
Meanwhile, the UK’s National Screening Committee is currently deliberating whether to implement a national prostate cancer screening program.
A spokesperson from NICE stated, “We are dedicated to ensuring our guidelines reflect the latest evidence and yield the best outcomes for patients. These guidelines are crafted by an independent committee of NHS clinical experts and undergo regular review to stay relevant. We’re in the process of updating our prostate cancer guideline, including recommendations on active surveillance, and will assess if our recommendations regarding age-related PSA thresholds for cancer referrals need adjusting.”
